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General NPI Number Information
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NPI Number | 1073571824
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Entity Type | Individual
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Provider Name | CHRISTOPHER DOMINGUE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 708 E MAIN ST
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City | OAK GROVE
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State | LA
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Zip | 71263-2500
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Country | US
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Telephone | 318-428-3200
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Fax | 318-428-7896
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Provider Business Mailing Address
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Address Line | 706 ROSS ST
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City | OAK GROVE
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State | LA
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Zip | 71263-9798
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Country | US
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Telephone | 318-428-3237
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Fax | 318-428-6180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 021327
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License Number State | LA
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